Deck 36: Adrenal Steroids

Question 1

Differentiate between the adverse-effects profile of the steroids,which have been designated FDA Pregnancy Category C,and select the appropriate information that must be given to a patient who is on steroid therapy and just learned that she is pregnant.

A) If she is going to continue treatment, the infant will have to be monitored for adrenal function after birth.
B) Chronic maternal steroid use in the first trimester can result in a cleft palate in newborns (about 1 percent incidence).
C) If she is going to continue treatment, her dose will be reduced to the lowest possible effective dose.
D) All of these are correct.

Answer 1

All of these are correct.

Question 2

Using the mechanism of action of aldosterone,select the correct symptoms associated with excessive use of this agent.

A) The major symptoms are edema, hypertension, arrhythmias, and muscle weakness due to the loss of potassium.
B) The major symptoms are dehydration, hypotension, arrhythmias, and muscle weakness due to the loss of water.
C) The major symptoms are thirst, hypotension, and muscle weakness due to the loss of water and sodium.
D) None of these are correct.

Answer 2

The major symptoms are edema, hypertension, arrhythmias, and muscle weakness due to the loss of potassium.

Question 3

Explain the process of catabolism that occurs in the body.

A) Catabolism is the breakdown of proteins into glucose in the liver.
B) Catabolism is the breakdown of proteins into amino acids in the skeletal muscle.
C) Catabolism is the breakdown of carbohydrates into amino acids in the skeletal muscle.
D) Catabolism is the breakdown of carbohydrates into glucose in the liver.

Answer 3

Catabolism is the breakdown of proteins into amino acids in the skeletal muscle.

Question 4

Compare the mineralocorticoids and glucocorticoids,and select the true statement about these hormones.

A) The glucocorticoids are hormones secreted by the inner layer of the adrenal gland.
B) Deficiency of mineralocorticoids leads to Cushing's disease.
C) The main effect of the mineralocorticoid hormones is to regulate the metabolism of carbohydrates and proteins.
D) The main effect of the mineralocorticoid hormones is to regulate the fluid balance of the body.

Question 5

Select the reason why alternate-day therapy is used in cases where prolonged use of steroids is necessary.

A) Alternate-day therapy is intended to reduce or eliminate the adverse effects of prolonged steroid treatment.
B) Alternate-day therapy is intended to facilitate treatment for patients with hectic or busy lifestyles.
C) Alternate-day therapy is intended to reduce or eliminate the stress on the liver that must metabolize the glucocorticoids.
D) All of these are correct.

Question 6

Use the pharmacological actions of the steroids to determine in which patients steroid use is contraindicated.

A) Patients suffering from gastrointestinal ulcers.
B) Patients suffering from renal disease.
C) Patients who have systemic fungal and local herpes infections.
D) Patients suffering from colitis.

Question 7

Select the most appropriate reason why a patient on warfarin therapy should not use the glucocorticoids.

A) Treatment with glucocorticoids while on warfarin therapy can lead to an inhibition of the action of the anticoagulant.
B) Treatment with glucocorticoids while on warfarin therapy can lead to an inhibition of the action of the glucocorticoid.
C) Treatment with glucocorticoids while on warfarin therapy can lead to potentiation of the action of the anticoagulant.
D) Treatment with glucocorticoids while on warfarin therapy can lead to potentiation of the action of the glucocorticoid.

Question 8

Select the adverse effects of excessive administration of the mineralocorticoids.

A) Increased gluconeogenesis
B) Sodium and water retention and loss of potassium
C) Increased protein catabolism
D) None of these are correct.

Question 9

Identify the hormone secreted by the anterior pituitary in response to the hypothalamus secreting corticotropin-releasing hormone (CRH).

A) Aldosterone
B) Adrenocorticotropin hormone (ACTH)
C) Dehydroepiandrosterone (DHEA)
D) Cortisol

Question 10

Select the adverse effect of high doses or long-term treatment with prednisone or hydrocortisone.

A) Redistribution of fat in the body, primarily localized in the face and shoulder region
B) Redistribution of fat in the body, primarily localized in the hips and buttocks region
C) Redistribution of fat in the body, primarily localized in the chest and stomach region
D) All of these are correct

Question 11

Use ACTH,cortisol,and 17-hydroxycorticosteroids to explain the process used in the diagnosis and treatment of Addison's disease.

A) ACTH is administered, and plasma levels of cortisol are measured. When the plasma level of this steroid does not rise or cannot be detected, primary adrenal failure, or Addison's disease, is present and short-term hormone replacement therapy must be started.
B) ACTH is administered and plasma levels of cortisol and 17-hydroxycorticosteroids (17-OHCS) are measured. When the plasma levels of these steroids do not rise or cannot be detected, primary adrenal failure, or Addison's disease, is present and short-term hormone replacement therapy must be started.
C) ACTH is administered and plasma levels of cortisol and 17-hydroxycorticosteroids (17-OHCS) are measured. When the plasma levels of these steroids do not rise or cannot be detected, primary adrenal failure, or Addison's disease, is present and chronic hormone replacement therapy must be started.
D) None of these are correct.

Question 12

Identify the factors that contribute to the physiological situation called stress.

A) Hot weather, infections, and anxiety are all forms of stress.
B) Exercise, cold weather, infections, surgery, and anxiety are all forms of stress.
C) Exercise, hot weather, surgery, and infections are all forms of stress.
D) None of these are correct.

Question 13

Select the true statement related to the factors that stimulate the hypothalamus to secrete corticotropin-releasing hormone.

A) The circadian rhythm is the very finely tuned control that maintains the day-to-day levels of cortisol at relatively constant amounts.
B) The sleep-wake cycle is the very finely tuned control that maintains the day-to-day levels of cortisol at relatively constant amounts.
C) Negative feedback is the very finely tuned control that maintains the day-to-day levels of cortisol at relatively constant amounts.
D) All of these are correct.

Question 14

Select the correct instructions for a patient with lupus erythematosus who is discontinuing long-term therapy with prednisone.

A) The dose of prednisone will gradually be reduced over a period of a few months.
B) The dose of prednisone can be stopped immediately.
C) The dose of prednisone will gradually be reduced every other day until completely weaned off.
D) None of these are correct.

Question 15

Match the term gluconeogenesis with the correct statement.

A) The process of making "new" glucose in the liver, where amino acids or glycerol are
B) converted into glucose. As a result, plasma glucose concentration rises and can be used by injured tissue or the brain.
C) The process of breaking down proteins into amino acids. This occurs mainly in skeletal muscle. The amino acids that are released can then be used by the liver to make new glucose.
D) The process of breaking down glucose in the liver.
E) None of these are correct.

Question 16

Using the mechanism of action of aldosterone,select the statement that best explains the sodium-potassium exchange.

A) Aldosterone increases the reabsorption of sodium ions and water. In exchange, potassium ions are transported into the urine. This process is usually referred to as sodium-potassium exchange. Consequently, normal sodium and water levels are maintained in the blood and other body tissues.
B) Aldosterone increases the release of potassium ions and water. In exchange, sodium ions are transported into the urine. This process is usually referred to as sodium-potassium exchange. Consequently, normal sodium and water levels are maintained in the blood and other body tissues.
C) Aldosterone decreases the reabsorption of potassium ions and water. In exchange, sodium ions are transported into the urine. This process is usually referred to as sodium-potassium exchange. Consequently, normal potassium and water levels are maintained in the blood and other body tissues.
D) None of these are correct.

Question 17

Select the mechanism of action of the glucocorticoids in the suppression of the inflammatory response.

A) The glucocorticoid hormone, ACTH, is transported to the target cell. ACTH passes through the plasma membrane into the cytoplasm, where it binds to the specific, high-affinity glucocorticoid receptor. The activated receptor-ACTH complex goes into the nucleus and binds to specific DNA elements to activate transcription of antiinflammatory proteins or prevent proinflammatory protein production.
B) The glucocorticoid hormone, CRH, is transported to the target cell. CRH passes through the plasma membrane into the cytoplasm, where it binds to the specific, high-affinity glucocorticoid receptor. The activated receptor-CRH complex goes into the nucleus and binds to specific DNA elements to activate transcription of antiinflammatory proteins or prevent proinflammatory protein production.
C) The glucocorticoid hormone, cortisol, is transported to the target cell. Cortisol passes through the plasma membrane into the cytoplasm, where it binds to the specific, high-affinity glucocorticoid receptor. The activated receptor-glucocorticoid complex goes into the nucleus and binds to specific DNA elements to activate transcription of antiinflammatory proteins or prevent proinflammatory protein production.
D) None of these are correct.

Question 18

Summarize the relationship between the hypothalamus,anterior pituitary gland,and adrenal gland.

A) The hypothalamus secretes ACTH (adrenocorticotropic hormone), which stimulates the release of CRH (corticotropin-releasing hormone). The CRH in turn stimulates the secretion of glucocorticoids and growth of the adrenal cortex.
B) The hypothalamus secretes CRH (corticotropin-releasing hormone), which stimulates the release of ACTH (adrenocorticotropic hormone). The ACTH in turn stimulates the secretion of mineralocorticoids.
C) The hypothalamus secretes CRH (corticotropin-releasing hormone), which stimulates the release of ACTH (adrenocorticotropic hormone). The ACTH in turn stimulates the secretion of glucocorticoids and growth of the adrenal cortex.
D) None of these are correct.

Question 19

Using adverse effects and pharmacological effects,determine the information you will need to educate a patient who is starting treatment on steroids.

A) Single steroid doses should be taken before 9 a.m. to allow distribution of drug to mimic diurnal levels without suppressing available adrenocortical activity.
B) Patients receiving high-dose or long-term therapy should not discontinue steroids without supervision of the prescribing physician to avoid precipitating symptoms of withdrawal.
C) Diabetics may have an increased blood glucose concentration requiring dose adjustment in insulin or oral antidiabetic drugs.
D) All of these are correct.

Question 20

Using metabolism and excretion as the primary factors,select the true statement related to the native and synthetic glucocorticoids.

A) The native and synthetic glucocorticoids are metabolized by the liver and then excreted in the urine.
B) The native and synthetic glucocorticoids are excreted in the urine, and the most common urinary metabolites of cortisol are the 17-hydroxycorticosteroids (17-OHCS).
C) The native and synthetic glucocorticoid metabolites of cortisol can be measured with a 24-hour urine collection and are used to provide an estimate of glucocorticoid secretion from the adrenal cortex.
D) All of these are correct.